| NPI | 1871862029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA SP321) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DTP606) |
| Enumeration Date | 2011-12-16 |
| Last Update Date | 2024-10-29 |